Healthcare Provider Details

I. General information

NPI: 1437084381
Provider Name (Legal Business Name): HOLISTIC NUTRITION PATHWAYS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 GLENN DR
WILBRAHAM MA
01095-1404
US

IV. Provider business mailing address

12 GLENN DR
WILBRAHAM MA
01095-1404
US

V. Phone/Fax

Practice location:
  • Phone: 413-695-2884
  • Fax:
Mailing address:
  • Phone: 413-695-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA ELLISTON
Title or Position: MEMBER/OWNER
Credential: LDN
Phone: 413-695-2884